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1.
《中华胸部外科电子杂志》2015,(1)
目的探讨食管异物的临床特点,总结食管异物的合理化诊疗经验。方法回顾性分析2008年1月至2013年12月上海市胸科医院收治的199例食管异物患者的临床资料。根据影像学及辅助检查结果将食管损伤程度分为无穿孔或局限性穿孔以及非局限性穿孔两类,第一类首选内镜治疗辅以保守观察,第二类首选手术治疗。总结分类治疗的效果。比较单纯内镜组与手术组在患者性别、年龄、就医时间以及异物类型与嵌顿部位上的差异。结果 176例患者在异物吞咽发生后48h内到该院就诊,超过48h就诊的23例;其中经食管镜或手术确认存在食管异物的共196例。异物中以鱼骨、家禽、家畜类骨为主(116例,59.1%),其次为义齿(31例,15.8%)。嵌顿部位位于食管第1狭窄处120例(61.2%),第2狭窄处63例(32.2%),第2狭窄处以下13例(6.6%)。食管无穿孔或仅为局限性穿孔的179例患者首选内镜治疗辅以保守观察,治疗成功175例(97.8%);内镜取异物失败或并发症转手术治疗3例,1例死于严重的纵隔感染。20例非局限性穿孔患者首选手术治疗。手术组就医时间大于48h的占30.4%(7/23),且均为尖锐性异物,就医延迟和尖锐性异物比例均明显高于内镜组的9.1%(16/176)(χ~2=9.066,P=0.003;χ~2=4.799,P=0.028)。结论异物的嵌顿部位与食管异物的类型及患者基础疾病密切相关。就医时间超过48h与尖锐型异物是需要手术介入的主要危险因素。辅以合理的麻醉方式,纤维食管镜能安全取出绝大多数食管异物。在食管异物的诊治中取出食管异物并非治疗的终点,遵循合理的诊疗流程判断并治愈异物吞咽所造成的损伤才是治疗的关键。 相似文献
2.
目的总结食管异物治疗经验,为食管异物的诊治提供借鉴。方法回顾性分析空军军医大学附属第二医院2011年12月—2019年5月共149例食管异物患者的临床资料,其中女75例(50.3%)、男74例(49.7%),平均年龄57(2~85)岁。结果146例经胃镜确诊,3例未发现异物。127例经胃镜取出,19例经手术治疗。食管异物以食源性为主,西北地区常见异物为枣核。48 h内取出异物黏膜损伤发生率为47.54%,48 h后取出异物者并发症发生率为100.0%。异物合并穿孔取出成功率低(P=0.005),超细胃镜在难取的颈部异物和其它部位异物差异无统计学意义(P=0.157)。结论异物越尖锐,越易穿孔;异物越早取出并发症越少;异物的大小决定内镜下取出的难易程度;确诊及治疗首选软式内镜,尤其是超细胃镜,内镜无法取出的异物再行手术治疗。 相似文献
3.
目的总结我国西北地区食管异物的发病特点与诊疗方法,为该病的临床诊治提供经验。方法食管异物病人202例,对异物的种类、嵌顿位置、诊断方法、取出方式、相关并发症、住院时间进行分析。结果 202例食管异物包括枣核(61. 8%)、动物骨头(12. 9%)以及非食物性异物如假牙(9. 4%)、金属类(7. 4%)、硬币(5. 0%)等。食管异物嵌顿的最常见位置为食管入口处(65. 8%),诊断主要依赖食管造影(57. 9%)、胸部X线片(19. 8%)或内镜检查(16. 4%)。取出异物的方式以食管镜为主,共189例(93. 6%),其余为胃镜取出或手术治疗。出现并发症者26例,其中18例异物为枣核。结论枣核是食管异物的主要来源,其术后出现并发症的几率较高。 相似文献
4.
上消化道异物的内镜取出术--附110例报告 总被引:1,自引:1,他引:0
目的 探讨上消化道异物的l临床特点及内镜取出术的方法及并发症。方法 总结我院1984年1月—2002年5月胃镜下诊治110例上消化道异物的临床资料。结果 内镜下异物取出成功率87.9%(5P4/107),并发症发生率10.6%(10/94)。不同种类异物取出成功率:长形异物100%(22/22),圆钝形异物85.7%(30/35),尖锐异物84.0%(42/50);并发症发生率:长形异物4.5%(1/22),尖锐形异物18.0%(9/50),圆钝形异物0。不同部位异物取出成功率:食管84.8%(39/46),胃91.8%(45/49),十二指肠90%(9/10);并发症发生率:食管13.0%(6/46),胃8.2%(4/49),十二指肠为0。结论 内镜上消化道异物取出术是有效、安全的方法。异物过大、过宽或怀疑有穿孔、患不配合时不宜经内镜取异物。 相似文献
5.
食管瘘的外科治疗 总被引:1,自引:0,他引:1
我院 2 0 0 1年 5月~ 2 0 0 2年 5月收治食管穿孔 1 9例 ,现将具体诊治方法及体会报道如下。1 .临床资料 :1 9例患者中男 8例、女1 1例 ;年龄 1 5~ 58 0岁。食管异物 (头饰、胸针、义齿等 ) 8例 ,其中异物直接导致食管穿孔 7例 ,在外院经口取异物时划破食管导致穿孔 1例 ;贲门失弛缓症球囊扩张导致穿孔 2例 ;自发性食管破裂穿孔 4例 ;食管癌介入治疗或放疗后穿孔 5例。发病至确诊时间 3~ 48h。8例食管异物及 2例自发性食管破裂的患者经手术修补瘘口。食管异物致食管穿孔部位在颈段食管 2例 ,上段食管 4例 ,中段食管 2例 ;瘘口长度 0 5c… 相似文献
6.
ERCP在医源性胆管损伤中的诊治价值 总被引:1,自引:0,他引:1
目的:探讨ERCP对医源性胆管损伤的诊断价值.方法:通过对22例医源性胆管损伤行ERCP检查,分析判断胆管损伤部位、程度及类型,根据需要进行内镜下扩张引流或取石治疗.结果:狭窄部位:位于肝总管近端3例(占13.6%),远端2例(占9.1%),总胆管中上段17例(占77.3%).其中环形狭窄4例(占18.1%),线形狭窄3例(占13.6%),闭塞型狭窄5例(占22.7%),胆管中断10例(占45.5%).内镜下治疗13例次,其中胆管探条扩张后放置7-8.5Fr内置架引流(ERBD)8例(占36.4%))(其中2例先行ENBD 1周后再行ERBD),乳头切开(EST)取石3例(占13.6%).结论:ERCP对医源性胆管损伤具有重要的诊治价值. 相似文献
7.
摘要目的用内镜食管扩张治疗食管狭窄,介绍纤光内镜下扩张器的使用方法。方法用 Savary-Gilliard 探条和Key Med 扩张器,对食管狭窄病人进行内镜扩张。结果 45例食管狭窄病人,作了157次内镜扩张治疗。症状Ⅰ级改善13.3/(6/45),Ⅱ级改善4.4%(2/45),治愈率80%(36/45),总有效率97.8%(44/45),1例食管扩张不成功。全组未发生任何严重并发症和因食管扩张术而死亡者。结论认为这两种扩张器治疗食管狭窄,方法简便、安全、疗效确实,值得推广使用。 相似文献
8.
目的探讨外科手术取食管异物的适应证及手术方法。方法采用外科手术摘除尖锐食管异物15例,其中颈段5例,胸段10例。5例颈段异物均合并脓肿,行脓肿切开引流同时取出异物;4例胸段异物摘除后施行改良食管腔内置管术;余6例取出异物后分层缝合食管切口。结果全组无死亡。4例施行食管腔内置管,术后1~2周中毒症状缓解,3~5周拔管后食管X线钡餐造影检查无穿孔或狭窄。1例切开食管取异物后发生右侧脓胸,术后第8d行脓胸廓清术及改良食管腔内置管,1个月后治愈;其余患者术后7~10d恢复经口进食。结论已穿透食管的金属异物和食管镜摘除易引起穿孔的尖锐异物应采用外科手术治疗,改良食管腔内置管对纵隔感染严重、无法修补的穿孔愈合是有帮助的。 相似文献
9.
目的探讨全身麻醉下食管异物取出术的优越性。方法回顾我科自1998年以来126例全麻下食管异物取出术的临床资料。结果本组共行手术126例,其中122例取出异物(96.8%),3例异物推入胃内,1例转入胸科治疗(0.8%)。结论患者全身麻醉下,由于肌肉松弛,操作时间充足,故可大大提高手术成功率,减少了手术并发症。 相似文献
10.
目的评价经黏膜下隧道内镜剥离术(ESTD)治疗食管浅表性肿瘤的效率及安全性。方法 74例食管浅表性肿瘤患者按病灶周径(1/3周,1/3~2/3周,2/3周)分层随机分为内镜黏膜下剥离术(ESD)组(36例)和ESTD组(38例),分别行ESD及ESTD治疗,比较各组的剥离面积、手术时间、剥离速度、整块切除率、治愈性切除率和出血、穿孔及术后狭窄等并发症情况。结果各组剥离面积无差异(P0.05)。在病灶周径1/3周时,两组的手术时间、剥离速度、整块切除率及治愈性切除率均差异无统计学意义(P0.05),在病灶周径1/3~2/3周及2/3周时,ESTD组的手术时间[(50.7±21.3)min及(61.7±29.8)min]明显短于ESD组[(79.8±19.5)min及(119.8±35.4)min](P0.05)、剥离速度[(21.1±5.6)mm~2/min及(28.8±6.1)mm~2/min]明显快于ESD组[(14.5±3.7)mm~2/min及(15.2±5.1)mm2/min](P0.05)。在病灶周径1/3~2/3周时,两组整块切除率及治愈性切除率均无差异(P0.05),在周径2/3周时,ESTD组整块切除率及治愈性切除率均高于ESD组(P0.05)。ESD组中,术中出血6例,术后迟发性穿孔2例,术后狭窄10例;ESTD组中,术中出血5例,术后狭窄13例,无穿孔发生。结论 ESTD能安全有效地切除食管浅表肿瘤,大面积食管肿瘤同传统ESD相比,具有手术时间短、剥离速度快、治愈性切除率高的优势。 相似文献
11.
食管穿孔83例分析 总被引:14,自引:0,他引:14
崔若恒 《中华胸心血管外科杂志》1994,10(2):141-143
83例不同原因引起的食管穿孔,保守治疗57例;手术26例,行单纯食管修补术20例、开胸行纵隔和/或胸腔引流2例、切除贲门肿物行胃食管吻合1例、颈部食管外置2例(其中1例并行二期结肠代食管手术)、1例开胸取异物形成食管瘘后,行二期修补瘘术。全组死亡8例,其中死于纵隔胸腔感染和主动脉破裂出血各4例。总治愈率85%。并指出异物假牙造成食管穿孔的重要性,对严重的腐蚀性食管灼伤应早期行食管镜检,并针对食管穿孔部位、种类、间隔期、纵隔与胸腔的感染程度及病人具体情况采取相应的治疗措施。 相似文献
12.
目的探讨食管破裂与穿孔的诊断与治疗,提高对该疾病的诊治水平。方法总结分析我科15例食管破裂与穿孔的临床病例资料。颈段食管穿孔3例,2例为异物所致,1例为外伤所致,均手术治疗,胸段食管破裂穿孔12例,其中自发性食管破裂穿孔4例,食管异物损伤5例,外伤性食管穿孔2例,医源性损伤1例,根据食管的损伤程度及感染累及范围分别采取食管切开异物取出食管修补,食管部分切除,纵隔引流,瘘口修补等手术治疗12例。结果15例食管破裂与穿孔治愈13例;1例死于合并糖尿病因胸腔和纵隔感染严重,中毒性休克,呼吸衰竭,肾功能衰竭;1例死于食管癌引发食管破裂穿孔致感染性休克,多器官衰竭。结论根据食管破裂与穿孔的大小、时间、部位、纵膈和胸腔污染程度,早期明确诊断,及时采取合适的手术方式是治疗的关键。 相似文献
13.
IntroductionEsophageal perforation in adults is most frequently caused by ingested foreign bodies. They can migrate through the esophageal wall, damaging the nearby organs such as the aorta or the trachea, with fatal outcome. After the diagnosis, the viable treatments for extracting the foreign body and repairing the perforation are several. The appropriate treatment, may be endoscopic, surgical or combined, depending on the level of the perforation, on the co-morbidities of the patient and on the available resources.Presentation of caseThis paper describes a case of a 68 years old patient with a double EP caused by a meat-bone that perforated the thoracic esophageal wall, approaching the aorta on the left side and the azygos vein on the right side.DiscussionBecause of the double transfixion and the position near the aorta and the azygos, it was not possible to remove safely the bone during the endoscopy. The management required a combined endoscopic and surgical approach. This way it was possible to detect easily the location of the perforation, to remove safely the foreign body, to repair the perforation both from the outside and from the inside, and to place the nasogastric tube under direct vision.ConclusionEven when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision. 相似文献
14.
Kalliopi Athanassiadi M Gerazounis E Metaxas Nikolitsa Kalantzi 《European journal of cardio-thoracic surgery》2002,21(4):653-656
OBJECTIVE: A retrospective study was conducted in 400 patients with esophageal foreign bodies (EFB) to assess characteristics of EFB and methods of treatment. METHODS: From 1962 through 1998, 400 patients with EFB were treated in our department on an emergency basis. There were 202 men (50%) and 198 women (49.6%) ranging in age from 1.5 to 95 years. The main symptoms patients complained of were difficulty in swallowing and pain. Detailed anamnesis, oropharynx and hypopharynx examination and finally radiological examination were the diagnostic tools. The location of the FB was in the cervical esophagus in 57% of cases, in the thoracic one in 26% and at the cardioesophageal junction in 17%. The most common objects found were bones, morsels, coins and needles. RESULTS: The treatment consisted of rigid esophagoscopy under general anesthesia in 343 (85.7%) of our cases. In 57 cases (14.3%) other means such as flexible esophagoscopy, Fogarty or Foley catheters and bougienage turned to be very useful. Only 12 patients (3%) were led to surgery because either extraction was impossible or perforation was present. No major complications occurred in the surgical group, whereas in the group of rigid esophagoscopy, there was one iatrogenous esophageal perforation that presented with empyema thoracis successfully treated. Finally, there was a case of an aortoesophageal fistula with mortal outcome perioperatively. CONCLUSIONS: (1) Esophagoscopy is a reliable method in the treatment of EFB impaction. (2) Alternative methods such as bougienage, etc., can be used only in selected cases with smooth foreign bodies. (3) Surgical treatment is unavoidable in cases of irretrievable EFB or esophageal perforation. 相似文献
15.
目的探讨食管异物病例需外科手术干预的危险因素。方法将1962年1月至2011年1月西安唐都医院胸外科收治并进行手术干预的43例食管异物病例作为研究对象;按性别和年龄(相差不超过5岁)进行匹配,选取同期经保守治疗的43例食管异物病例作为对照。收集资料包括异物类型、异物存留时间、异物存留部位、是否伴有并发症。采用单因素及多因素条件logistic回归分析来明确食管异物病例需手术干预的危险因素。结果单因素分析显示,异物类型、异物存留时间、异物存留部位、是否伴有并发症是食管异物需手术干预的危险因素(均P〈0.05)。多因素分析显示.异物类型(锐性异物)是食管异物需手术干预的独立危险因素(P=0.043;OR=29.228,95%CI:1.114~766.686)。结论锐性食管异物应引起临床医师的高度重视,可结合异物存留时间和存留部位及是否伴有并发症等因素决定是否进行手术治疗。 相似文献
16.
Purpose The high mortality associated with esophageal perforation can be reduced by aggressive surgery and good critical care. We report our experience of treating esophageal perforation in a clinic in Taiwan.Methods The subjects were 28 patients who underwent surgery for a benign esophageal perforation.Results The esophageal perforation was iatrogenic in 11 patients, spontaneous in 8, and caused by foreign body injury in 9. Most (22/28) of the patients were seen longer than 24 h after perforation, and 77% had empyema preoperatively. The perforation was located in the cervical area in 5 patients and in the thoracic esophagus in 23. We performed primary repair in 24 patients, esophagectomy in 3, and drainage in 1. Leakage occurred after primary repair in ten (41%) patients, resulting in one death, and two patients died of other diseases. Postoperative leakage prolonged the hospital stay but had no impact on mortality. Overall survival was 90%. Univariate analysis revealed that age, timing of treatment, and cause and location of the perforation influenced outcome, but multivariate analysis failed to identify a predictor of mortality.Conclusions Early diagnosis and intervention are crucial to prevent morbidity and mortality in patients with esophageal perforation. Primary repair is feasible even if the diagnosis is delayed. 相似文献
17.
Esophageal foreign bodies in adults. 总被引:13,自引:0,他引:13
J Herranz-Gonzalez J Martinez-Vidal A Garcia-Sarandeses C Vazquez-Barro 《Otolaryngology--head and neck surgery》1991,105(5):649-654
The main point in managing suspected impaction of esophageal foreign bodies is to decide whether the patient needs an esophageal endoscopy. Decision-making is based on clinical history, physical examination, and radiographic studies. We review 100 cases of adults having esophagoscopy for removal of esophageal foreign bodies. Fish bones were the most frequently responsible foreign body and the cervical esophagus was the most frequent level of impaction. Decision-making based on clinical history and patient-referred symptoms revealed a positive esophagoscopy in 72% of the suspected cases. Radiographic studies gave falsely positive and falsely negative information in 30% of the cases. Rigid esophagoscopy was used successfully for foreign body removal in 99% of the cases. Average hospital stay was 3.2 days. No complications associated with the use of a rigid esophagoscope were found. 相似文献
18.
Little DC Shah SR St Peter SD Calkins CM Morrow SE Murphy JP Sharp RJ Andrews WS Holcomb GW Ostlie DJ Snyder CL 《Journal of pediatric surgery》2006,41(5):914-918
Background
Children with esophageal foreign bodies are frequently seen by pediatric surgeons. Choking and dysphagia are common presentations; however, esophageal perforation has been reported. Historically, rigid esophagoscopy with extraction of the foreign body has been the recommended treatment. Alternatively, Foley balloon extraction is a safe and effective approach.Methods
Over a 16-year period, 555 children presented with an esophageal foreign body. Retrospective analysis of the medical record was undertaken. Statistics were by univariate analysis.Results
Two hundred ninety-eight boys and 257 girls presented with a mean age of 3.24 years. Dysphagia (37%) and drooling (31%) were the most common symptoms. Foreign bodies were lodged in the superior esophagus in 73%, and 88% of the objects were coins. Balloon extraction with fluoroscopy was performed in 468 children. Eighty percent of the objects were successfully removed with a mean fluoroscopy time of 2.2 min, and 8% were advanced into the stomach. The overall success rate was 88%, with failures necessitating rigid esophagoscopy under general anesthesia. Children younger than 1 year were the most likely to fail (25% failure rate). Airway aspiration never occurred. Significant savings in patient charges were observed with this approach.Conclusions
Balloon extraction of pediatric esophageal foreign bodies is a safe and cost-effective procedure. This technique is applicable for infants, children, and adolescents. Experienced practitioners should be able to achieve greater than 80% success rate. 相似文献19.
Scamporrino A Mongardini M Stagnitti F Corona F Costantini A Priore FM Tiberi R Iannetti A Occhigrossi G 《Il Giornale di chirurgia》2002,23(6-7):261-267
From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions. 相似文献
20.
Stojakov D Sabljak P Bjelović M Dunjić M Nenadić B Ebrahimi K Spica B Velicković D Dukić V Saranović Dj Djurić-Stefanović A Pesko P 《Acta chirurgica Iugoslavica》2004,51(1):93-101
Iatrogenic perforations of the esophagus and hypopharynx are important problem, due to diagnostic difficulties, controversies about adequate treatment, and high morbidity and mortality rate. Incidence of iatrogenic perforations is from 50 to 75% of all perforations. In the period from April 1999. to April 2004, 15 patients with iatrogenic perforation of the esophagus and hypopharynx were treated at the Department of esophageal surgery, First University Surgical Hospital in Belgrade. In majority of patients iatrogenic perforation occured during endoscopic interventional procedure (endoscopic removal of ingested foreign body--10 pts, endotracheal intubation--2 pts, intraoperative iatrogenic perforation--2 pts, pneumatic dilatation--1 pt). Surgical treatment was performed in 12 (80%) pts and 3 (20%) pts were treated conservatively. Surgical approach was cervicoabdominal, thoracoabdominal and cervicothoracoabdominal in 9.1 and 2 pts, respectively. Among 12 operated pts, primary repair of the esophagus was performed in 5 pts, and esophageal resection or exclusion in 7 pts. Overall mortality rate was 13.3% (2 pts), in surgical group 8.3% (1 pt) and in conservatively treated group 33.3% (1 pt). Iatrogenic perforations of the esophagus and hypopharynx are diagnostic and therapeutic problem. Awareness of the possibility of esophageal perforation during instrumental manipulations and early diagnosis is essential for successful, individually adapted, and in most cases surgical, treatment. 相似文献